Purpose: To assess and compare the periodontal health status among permanent residents of low, optimum and high fluoride areas in Kolar District, India. Materials and Methods: A house-to-house survey was conducted in a population consisting of 925 permanent residents aged 35 to 44 years in three villages having different levels of fluoride concentrations in the drinking water. The fluoride concentrations in selected villages were 0.48 ppm (low), 1.03 ppm (optimum) and 3.21 ppm (high). The ion selective electrode method was used to estimate the fluoride concentration in the drinking water. Periodontal status was assessed using the Community Periodontal Index (CPI) and loss of attachment (LOA). Results were analysed using the chi-square test and logistic regression. The chi-square test was used to find the group differences and logistic regression to find association between the variables. Results: The overall prevalence of periodontitis was 72.9%; specifically, prevalences were 95.4%, 76.3% and 45.7% in low, optimum and high fluoride areas, respectively. The number of sextants with shallow or deep pockets decreased (shallow pockets: 525, 438, 217; deep pockets: 183, 81, 34) from low to high fluoride areas (odds ratio: 71.3). The low fluoride area had a 7.9-fold higher risk of periodontitis than the optimum fluoride area and a 30-fold higher risk than the high fluoride area, which was highly significant (χ2 = 53.5, P 0.0001 and χ2 = 192.8, P 0.001, respectively). Conclusions: The severity of periodontal disease is inversely associated with the fluoride concentrations in drinking water. This relation can provide an approach to fluoride treatments to reduce the prevalence or incidence of this disease. Keywords: CPI, endemic areas, fluoride, loss of attachment, periodontal health, periodontitis